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          67:16:01:28.  Rates and procedures subject to review and amendment -- Provider may request review. Rates paid under the provisions of article 67:16 and posted on the department's website located HERE are subject to review and amendment by the department.

 

          A provider may request that the department review a particular reimbursement rate for possible adjustment or request the inclusion or exclusion of a particular procedure code, item, or service for payment purposes. The request must be in writing. When reviewing a request, the department shall review paid claims information, Medicare fee schedules, national coding lists, and documentation submitted by the provider or the associated medical professional organization to determine whether a change is warranted. When the review is complete, the department shall notify the provider in writing of the results of the department's review.

 

          Source: 35 SDR 49, effective September 10, 2008.

          General Authority: SDCL 28-6-1, 28-6-1.1.

          Law Implemented: SDCL 28-6-1, 28-6-1.1.

 


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